Addiction is a powerful enemy, and the weapon to fight it – namely, treatment – is similarly potent. When wielded improperly, carelessly or unprofessionally, treatment can be as damaging and destructive as the addiction it is supposed to combat. That is why treatment accreditation exists: to promote healthy rehabilitative institutions and practices, and to protect families and their loved ones from people who have no business accepting money for the unfounded help they claim to offer.
Why Should Treatment Be Accredited?
You may wonder, what is the necessity behind accrediting and licensing treatment facilities? It’s the same line of reasoning behind the reason that hospitals receive government, state and private endorsements: taking charge of a person’s physical and mental well-being – especially from the clutches of a substance abuse problem or other form of addiction – is a matter of life and death, and the people who need those services deserve to know that their health is in good hands.
The American Journal of Managed Care explains that regulatory organizations have “important roles in ensuring the quality of healthcare.” Various agencies have various focuses, missions and structures, so that every conceivable treatment base is covered. The journal concluded that the goal of accreditation is to establish standards and periodically raise those standards to deliver higher levels of care to patients and their families.
All of this sounds reasonable, but the idea of accrediting rehabilitation facilities has some very good, and very serious reasons. The Journal of Psychoactive Drugs profiles sober living houses, also known as “sober houses,” as homes (or a collected group of homes) that have enforced drug- and alcohol-free policies for people looking to stay clean after a period of substance abuse and addiction. Addicts are allowed to acclimatize to a life with discipline and structure after they complete their course of formalized treatment, before fully reintegrating with the outside world. While commendable in theory, the practical reality is more concerning: the journal explains that many such homes are neither funded nor approved by state or local authorities.
For example, the Arizona Central points out that a number of sober house facilities are merely rental home owners – without degrees in mental health, licenses from official organizations, or certifications from government or private agencies, and who lack the skill and resources in proper recordkeeping and documentation of patients and their conditions – opening their doors to recovering substance abusers. As a result, the facilities are not properly geared toward housing multiple people with specific medical needs, so ordinary bedrooms and living rooms have to double as living and sleeping spaces for several residents.
The owners of such facilities don’t want to register their sober houses with the authorities for fear that they would not be able to afford the licensing fees or taxes, and that they would be inevitably forced to close because their homes could never adhere to state and/or local requirements.
Problems with unregulated sober facilities can run dangerously deep. Since most sober homes are run independently, they have different rules regarding conduct, but there are some standard practices required of residents to continue living at the establishment:
- Complete abstinence from all harmful behaviors (drinking and using drugs)
- Consent to random searches of living quarters and their clothing
- Pass random urine tests
- Hold down a regular job
- Pay on time (usually in cash)
- Attend group therapy sessions
These kinds of expectations are very important in providing a foundation and path for the addict on their road of recovery, especially in the first three months after leaving formalized treatment. However, sober living homes that do not have professional oversight can lack the proper methods of dealing with patients who cannot, or do not, meet these criteria. The NJ (New Jersey) Spotlight reports the story of a 24-year-old man who overdosed on heroin after being evicted from the sober home he was in because of a relapse. In response to his mother’s query, the facility attempted to distance itself from responsibility, explaining that the patient was an adult who had made his own choice.
In response, the man’s mother started working with lawmakers on enforcing regulatory standards on sober living houses, such as informing the next of kin if a resident is evicted. An assemblywoman described privately operated sober houses as “rogue rehabs,” capable of being set up in a neighborhood without notice or informing the residents of the area. However, some sober living facilities objected to the proposed bill, arguing that the legal burden it would place on some establishments would be so great as to drive them out of business. Others (including a recovering addict who is the president of a sober living foundation and a facility operator) pointed out that unofficial sober houses provided a cost-effective alternative to patients who cannot afford the services offered by a regulated rehab facility.
Perhaps there are points to be made for unsupervised sober houses providing services to recovering addicts, but the Federal Trade Commission warns that many of these programs lack even a standard definition for what they do. Some of them call themselves “therapeutic boarding schools,” while others go by “emotional growth academies,” “behavior modification facilities,” and, in one case, a “wilderness therapy program.” In 2007, the U.S. Congress heard a report from the Government Accountability Office of cases of “serious abuse and neglect” in some of these programs.
There is only the thinnest concept of credibility or accountability from independently owned sober housing, which is why proper treatment center accreditations exist. For example, the Federal Trade Commission mentions programs like JACHO – formerly the Joint Commission on Accreditation of Healthcare Organizations, but today simply known as The Joint Commission. JAHCO is a non-profit organization that accredits more than 20,500 healthcare programs and services in the United States. Its stated mission is to improve public healthcare by evaluating the organizations that provide care, and motivating them to improve their standards.JAHCO accreditations are good for three-year cycles, and facilities regulated by JAHCO have to be up to date on current standards and practices in mental health and substance abuse and addiction treatment, account for current processes (and related policies and procedures), and demonstrate an ability to improve any areas that are not in compliance.
The Council on Accreditation (COA) is another regulatory organization for the administration of mental health care facilities. COA focuses on services for children and families, such as the Joint Council on International Children’s Services, the Alliance for Children & Families, and the Florida Coalition for Children. COA offers accreditation for private organizations and public agencies, as well as development programs for children and youth that are based on behavioral health and community-based welfare. For private organizations, COA regulates their administrative and management standards, the standards of service delivery and the service itself. Accreditation lasts for four-year cycles and can take as long as 18 months to secure, with the assistance of a COA accreditation coordinator.
The Commission on Accreditation of Rehabilitation Facilities (CARF) has been in operation since 1966, and it exists to provide standards of accreditation to healthcare organizations worldwide. CARF oversees facilities specializing in behavioral health, psychosocial rehabilitation, child and youth services, medical rehabilitation, employment and community services, and opioid treatment programs.
CARF explains that treatment accreditation is intended to provide patients and their families with a variety of reliable and trustworthy options when searching for a facility that meets their needs. Accredited organizations are required to submit a report to CARF for each year of their accreditation term. Based on the organization’s application, self-evaluation, and CARF oversight, the accreditation term might be for three years, one year, or for a provisional period of time. The report should show the organizations have made improvements in areas that CARF identifies as criteria for continued affiliation and endorsement.
The United States government, under the Department of Health and Human Services, also assumes responsibility for regulating treatment facilities. The Substance Abuse and Mental Health Services Administration (SAMHSA) sponsors its own accreditation agencies to make site visits and review organizations providing drug, alcohol and other forms of substance abuse treatment, ensuring the services, practices, procedures and policies of such facilities meet exact, accepted standards for organizational operations and patient care.
SAMHSA explains that such measures enhance community confidence in treatment programs, educate staff to better take care of their residents, improve recruitment guidelines, and help treatment facilities meet licensure requirements put down by local and state governments.
‘Abusive and Unethical’
PBS explains that, for cases of teenage and young adult substance abuse, parents are often so desperate for help that they may not think to ask the operator of a sober facility for their credentials. Does he or she have the necessary or appropriate advanced degree, like a master’s degree in social work? Does he or she have the required license to perform clinical social work (especially for the need that the parents or other family members have identified is best for their loved one), and is the facility itself licensed? Does the operator have the relevant licensure and accreditation documents on hand?
The result of not carrying out due diligence, warns PBS, could be unwittingly putting your loved one into a program that is abusive and unethical.
 “Accrediting Organization and Quality Improvement.” (October 2000). The American Journal of Managed Care. Accessed February 1, 2015.
 “What Did We Learn From Our Study on Sober Living Houses and Where Do We Go From Here?” (December 2010). Journal of Psychoactive Drugs. Accessed February 2, 2014.
 “Booming Sober-House Industry Lacks Oversight.” (April 2013). The Arizona Republic. Accessed February 2, 2015.
 “Aftercare: A Fundamental Tenet in Attaining Long-Term Recovery” (January 2013). Intervenenow.com. Accessed January 25, 2015.
 “Tighter Regulation Sought for “Sober Living” Homes for Recovering Addicts.” (September 2014). NJ Spotlight. Accessed February 2, 2015.
 “Evaluating Private Residential Programs for Troubled Teens.” (July 2008). Federal Trade Commission. Accessed February 2, 2015.
 “Residential Treatment Programs for Teens.” (July 2008). Federal Trade Commission. Accessed February 2, 2015.
 “About the Joint Commission.” (n.d.) The Joint Commission. Accessed February 2, 2015.
 “Private Organization Accreditation.” (n.d.) Council on Accreditation. Accessed February 2, 2015.
 “Opioid Treatment Program.” (n.d.) CARF International. Accessed February 2, 2015.
 “Steps to Accreditation.” (n.d.) CARF International. Accessed February 2, 2015.
 “Opioid Treatment Program Accreditation.” (n.d.) Substance Abuse and Mental Health Services Administration. Accessed February 2, 2015.
 “Abuses in Programs for Struggling Teens: The Legacy of Scandal.” (n.d.) PBS. Accessed February 2, 2015.
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.